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HYPERPARATHYROIDISM. CASE REPORT ILLUSTRATING SPONTANEOUS REMISSION DUE TO NECROSIS OF ADENOMA, AND A STUDY OF THE INCIDENCE OF NECROSES IN PARATHYROID ADENOMAS*
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1953
Year
UrologySpontaneous NecrosisClinical Entity HyperparathyroidismEndocrine DiseaseMedicineParathyroid HormoneParathyroid AdenomaParathyroid DiseasePathologyParathyroid GlandAnd A StudyEndocrinologyChronic Kidney DiseaseNephrologyRadiology
The majority of patients suffering with the clinical entity hyperparathyroidism are found to have adenomas of one or more parathyroid glands, and the pathologic physiology of the disease is corrected by surgical removal of the tumor. One would expect the hormonal output of an hypersecreting adenoma to be approximately constant, perhaps increasing gradually with anatomic enlargement of the tumor, but hardly fluctuating widely from week to week or from month to month. Yet soon after hyperparathyroidism was recognized (1, 2, 3), it began to be noted that certain patients seemed to have spontaneous remissions of the disease (4, 5), as judged symptomatically, radiographically and by serum chemical changes. The clinician may, therefore, be justifiably worried when he is confronted by a patient who has had renal calculi containing calcium, hypercalciuria, hypercalcemia and hypophosphatemia, and perhaps even roentgenographically suspicious evidence of hyperparathyroidism, yet who at the time of examination presents none of the chemical abnormalities upon which a diagnosis of hyperparathyroidism might comfortably rest. It has been our custom, and that of some other clinics, to follow such patients at intervals before dismissing a parathyroid adenoma from the diagnostic possibilities; and on occasions one is rewarded a few months later with clear-cut chemical evidence of hyperparathyroidism. But no feasible explanation has offered itself for these rare instances of spontaneous remissions and relapses in this disease. A patient was seen recently whose parathyroid adenoma was the seat of a spontaneous necrosis; and, coincident with this, the hyperparathyroidism disappeared just as if the adenoma had been surgically removed. We were thereby prompted to review the available specimens of parathyroid tumors which had been surgically removed in this hospital for evidence of previous necrosis.